First Response Business?

[FirstResponderOR]

A buddy and I were looking into starting a First Response business for the area we live in. Basically we just want to have a business that responds to emergencies that are either

1. Require additional assistance

2. closer to us than the local fire/ems

and 3. give basic boo boo support

We were curious on how to start this. We will not be transporting patients, so no need for an ambulance. We were thinking more along the lines of POV's instead of ambulances.

Thats pretty much all we want to do. Be the first response to emergencies that fit certain criteria.

We both live in the State of Oregon and have no idea how or where to begin.

Any advice would be helpful!

Thanks!

Wesley

[akflightmedic]

Not even sure where to begin on this one...

Who will regulate or authorize you to do this?

Is a certificate of need necessary? If so, will local services allow you?

Will the county council allow you?

Will the state allow you?

Who will be your medical director?

How will you afford him?

Insurance on vehicles, malpractice and general stupidity?

How will you be paid for this service?

How will you be notified to respond?

Who will you answer to outside of your medical director regarding business practices?

How are you going to pay/afford all the overhead?

Man there is so much bad about this idea and absolutely no good which is why this is typically left up to fire departments or government subsidized services.

Even legitimate ambulance calls have issues with reimbursement and you think you are gonna get paid for a First Responder business???

Good Luck...but from one business man to an up and coming entrepreneur...let it go and decide on something else.

[tniuqs]

Just a few questions there AK ?

Dear Paramedic Student ? Westley:

Have you and your significant other (btw I hope s/he is an MD) entertained the possibility of asking the local fire dept or EMS to become members ? It sounds like a great concept i.e. fulfilling a perceived need for your community "in theory" but, answer the above questions before you even purchase an O2 tank.

From a buisness perspective: Have you crunched the potential call volume vs cost of investment i.e. as in a well thought out (on paper) business plan to start with ?

One option you possibly could entertain (after answering ALL of AKs questions) is a SAR team (if your so inclined and have some experience prior) for your area, and just ground pounders no specialist marine or high angle stuff) not really aware of the rules regs and politics in Oregon but in Canada specifically Alberta this can be accomplished under a thing called "The Societies Act" typically "non profit" and cost recovery for fuel and expenses only. That said a minimum of 12 core members to realistically cover 24/7 (unless you and your buddy are independently wealthy) and if you are, I would be most pleased to provide my services as a highly paid consultant

Reminds me of a story a beer drinking friend always spoke about (well more or less) :

There are many ways to skin a cat, but you do need a cat to proceed.

cheers and good luck, bigger thing's have been accomplished with lesser ideas.

[DwayneEMTP]

A buddy and I were looking into starting a First Response business for the area we live in. Basically we just want to have a business that responds to emergencies that are either

1. Require additional assistance

2. closer to us than the local fire/ems

and 3. give basic boo boo support

We were curious on how to start this. We will not be transporting patients, so no need for an ambulance. We were thinking more along the lines of POV's instead of ambulances.

Thats pretty much all we want to do. Be the first response to emergencies that fit certain criteria.

We both live in the State of Oregon and have no idea how or where to begin.

Any advice would be helpful!

Thanks!

Wesley

Hey Westley, welcome to the City!

Yeah, this is not going to work out for you brother. Not to mention I'm guessing the the 'certain criteria' will be car accidents, house fires, active arrests...all the glory stuff and none of the lift assists? It would be a sweet gig....pick the interesting calls, fire up the lights and sirens on your Toyota, show up and be heros while the hero shit is going on, leave before the non hero clean up, care, and transport begins, and skip the paperwork, and then get paid? No lift assists, no frequent fliers, none of those stupid, 'boring' calls? Hell, I think I just came in my pants!

Doesn't work that way brother. You wanna go behind the yellow tape? You gotta pay to play...simple as that.

Dwayne

[FirstResponderOR]

Hey Westley, welcome to the City!

Yeah, this is not going to work out for you brother. Not to mention I'm guessing the the 'certain criteria' will be car accidents, house fires, active arrests...all the glory stuff and none of the lift assists? It would be a sweet gig....pick the interesting calls, fire up the lights and sirens on your Toyota, show up and be heros while the hero shit is going on, leave before the non hero clean up, care, and transport begins, and skip the paperwork, and then get paid? No lift assists, no frequent fliers, none of those stupid, 'boring' calls? Hell, I think I just came in my pants!

Doesn't work that way brother. You wanna go behind the yellow tape? You gotta pay to play...simple as that.

Dwayne

We didn't plan on just showing up and leaving. And i'm pretty sure on every call you have to fill out your PCR's.

And as an FYI we weren't planning on having a profit business. We aren't in it for the money, just to help people.

You guys make too many assumptions and think that everyone just wants money. As for a medical director, we

could have one in minutes.

All we were interested in was trying to figure out the steps to get something started, but you guys start with your ego.

We all know its not show play go. We planned on helping during and after. Just no transport due to the fact were EMR

not Basics or PM's. More or less, it was just volunteer work for us. Apparently you guys cant think of that maybe because

you guys are just in it for the money. Not for the genuine interest of helping people.

And to answer the question you'll probably ask next. We planned on doing non emergency transports. Due to the fact

we live in a town that is located 30 miles from the city, sometimes doctor appointments are difficult for the elderly or even

those that have different circumstances.

I've been at the scene of a crash many times as just a civilian (in my toyota), but stopped and assisted anyways. All the way to the very end.

So thank you for your perceptions, but maybe you shouldn't get your panties in a bunch just because your higher up and have more

responsibility.

Not even sure where to begin on this one...

Who will regulate or authorize you to do this?

Is a certificate of need necessary? If so, will local services allow you?

Will the county council allow you?

Will the state allow you?

Who will be your medical director?

How will you afford him?

Insurance on vehicles, malpractice and general stupidity?

How will you be paid for this service?

How will you be notified to respond?

Who will you answer to outside of your medical director regarding business practices?

How are you going to pay/afford all the overhead?

Man there is so much bad about this idea and absolutely no good which is why this is typically left up to fire departments or government subsidized services.

Even legitimate ambulance calls have issues with reimbursement and you think you are gonna get paid for a First Responder business???

Good Luck...but from one business man to an up and coming entrepreneur...let it go and decide on something else.

To answer your questions:

Who will regulate or authorize you to do this?

I dont know, thats why I made the posting here............

Is a certificate of need necessary? If so, will local services allow you?

Depends what certificate your talking about. If your talking about practice certificates, yes we have them.

Will the county council allow you?

As far as I know.

Will the state allow you?

The lady hasnt returned my voice message at the present moment.....

Who will be your medical director?

We have a friend with an MD that the board approves of.

How will you afford him?

Hes free......

Insurance on vehicles, malpractice and general stupidity?

Already have vehicle insurance as for the rest, I posted this.... yet again.......

How will you be paid for this service?

Insurance for Non Emergency Transports, and other sources.

How will you be notified to respond?

I would assume our local dispatch center....

Who will you answer to outside of your medical director regarding business practices?

This didn't make sense to me.

How are you going to pay/afford all the overhead?

Supplies are pretty cheap for this level of service.

The supervisor is free.

Insurance is almost taken care of.

And no, we didnt plan on getting paid, just doing it for the fact we actually want to and like to help people.

[DwayneEMTP]

It would seem my young friend that you are in fact the one with their panties in a bunch.

See, you came here with a misconception. The 8 hr class you took to become a first responder convinced you that you were given tools to be helpful at the scene of an accident. But you were misinformed. That is not me being arrogant because I'm 'higher up' than you, that is simply a fact. Police first responders can sometimes be helpful because they come with a skill set that prepares them to deal with emergencies, volunteer first responders can sometimes be helpful, but are most times just in the way. They simply don't come with very many tools and little to no experience...they are meant to help those that come to help people.

You try and insult us by claiming that perhaps we do this 'just for the money', and yet I spent nearly three years in college full time becoming a paramedic. How much time have you spent in your quest to 'help people?' A day, right? Give or take a few days? And you've not even become committed enough to your passion to take the necessary steps to volunteer. Time for a reality check man.

I'm sorry that you didn't get the Rah Rah response from this professional board that you got from your mom and dad. You came in here with a decent post, were treated with a little bit of tongue and cheek fairness, and you got ass hurt. That's the down side.

The upside? You didn't run away...and that shocked me. I've done paramedic medicine on the streets, in Afghanistan, and now on the ocean, and my experience pales in comparisson to most here. You really need to take a check when you begin to compare passions and commitments and motivations. But you didn't run away...so maybe you will have what it takes to become what it is you seem to want to be....We'll see.

Your post was well written, with good spelling and grammar. Pretty cool...

Thanks for participating brother...I look forward to your thoughts.

Dwayne

(Edited for an after thought;) Also Westley? It's only at your current level of training that caring for people for money sounds like blasphemy. The vast, vast, vast majority of intelligent, kind, caring professionals in the medical fields get paid man...suggesting that you were going to get paid was not an insult. See?

Edited June 3, 2011 by DwayneEMTP

[usmc_chris]

And to answer the question you'll probably ask next. We planned on doing non emergency transports. Due to the fact

we live in a town that is located 30 miles from the city, sometimes doctor appointments are difficult for the elderly or even

those that have different circumstances.

Do you have CDL's and/or a livery driver's license? How about state authorized livery vehicles? The laws may vary from state to state, but for the kinds of transports you're talking about, similar requirements to a taxi service apply. In the case of "medically necessary" transports, such as the bed-confined or oxygen dependent population, you would have to become a fully licensed/certified ambulance service the EMT-B level or higher.

Who will regulate or authorize you to do this?

I dont know, thats why I made the posting here............

Is a certificate of need necessary? If so, will local services allow you?

Depends what certificate your talking about. If your talking about practice certificates, yes we have them.

You need to check with your local emergency response squads. Before a Certificate to operate (if required for BLSFR in your state) is issued, the state will often ask for their approval. And I don't believe this question meant 'practice' certificates, as in your CFR/EMR certification card. What is meant, is a certificate of need/public convenience/whatever your area calls it, which essentially means that the State agrees that this service is needed/will be useful, and authorizes you to run the service. Without said certificate, you simply cannot operate. The State office of EMS would have more information on this process.

Insurance on vehicles, malpractice and general stupidity?

Already have vehicle insurance as for the rest, I posted this.... yet again.......

No, you don't already have the insurance on your vehicles, I would guess. Standard automobile insurance WILL NOT cover your response to emergency incidents. It REALLY won't cover you if you do the non-emergency transport thingy you were talking about as well. If they find out you're doing this, they'll drop you like a hot potato. You need to purchase coverage through one of only a few specialized insurance plans that covers authorized emergency vehicles. It WILL cost more than your standard coverage.

As for malpractice insurance, there's a few different options. I personally have a policy through HPSO, but I don't know if they issue agency policies, which is what you would need. It's around $200 a year for Paramedic-level coverage, I have no idea what personal EMR/EMT-B level coverage would cost (I never got my own coverage until I had the stuff I could REALLY hurt people with, just relied on my employer).

How will you be paid for this service?

Insurance for Non Emergency Transports, and other sources.

Do you know anything about billing insurance carriers? It's not that easy. You have to have a certificate to operate and all the other necessary stuff. You would need to legally incorporate. Once that is done, you'd have to apply to CMS for a Medicare billing number (since most of the folks you're talking about transporting would be on Medicare). Once that's issued, you can apply to the State for a Medicaid billing number. You can't bill either program without their respective billing numbers.

How will you be notified to respond?

I would assume our local dispatch center....

I hate to break it to you, but there will most likely be a cost to this. Municipalities/counties, depending on your state, are often required to take 911 calls, but they often have no legal obligation to provide dispatching services, at least for free. Even if the dispatching service is free, radios/pagers will set you back THOUSANDS of dollars. I can guarantee those won't be free.

How are you going to pay/afford all the overhead?

Supplies are pretty cheap for this level of service.

The supervisor is free.

Insurance is almost taken care of.

You probably need to rethink the above. Just getting this off the ground could be in excess of $100,000. I would suspect that your personal vehicles would not be approved for use (there are some states that would allow it, but your insurance carrier may not). Even if your personal vehicle were approved for use, do you want the PERSONAL liability attached to using it? There's a certain level of protection if you have a "company owned" vehicle for use instead. Portable radios are easily $500 each. Tone-activated pagers are around $400 each last I knew. I have no clue how much a mobile radio for your response vehicle would cost.

As for supplies, sure, disposable supplies are pretty cheap. But I guarantee that your state has a "minimum equipment list" for BLSFR services. This would almost certainly include non-disposable, durable supplies that will quickly add up. Among them include an AED, probably a short board or KED, and some sort of portable suction unit. Those three things alone will set you back almost $4,000 easily.

And no, we didnt plan on getting paid, just doing it for the fact we actually want to and like to help people.

But that's not you said. You did in fact allude to getting paid for non-emergency transports. The problem is, the non-emergency medical transport industry and the BLSFR 'industry' are two completely separate things. You would need to be separately licensed for each. You would probably need different vehicles for each.

I realize you think everybody's jumping on your back, but we're just trying to give you a dose of reality. If there's truly a need for either of these things, you can make it happen, but it can't be just your buddy and yourself. It really truly would take total community involvement. The reason that some people are jumping at you is that you described it from the outset as a "business." The word business has a connotation that a profit is involved. Most of us understand that is not necessarily the case, but in the context you used it, it certainly sounded as if you wanted to make a profit. A better term would have been a "service" or "non-profit" etc., if you really don't intend to make money.

I wish you luck in your endeavors, but I would strongly suggest thinking this over more before you jump in with both feet.

[akflightmedic]

Who will be your medical director?

We have a friend with an MD that the board approves of.

How will you afford him?

Hes free......

Who will you answer to outside of your medical director regarding business practices?

This didn't make sense to me.

Wait until he sees the increase on his medical malpractice coverage and then wait until his first complaint (which is a matter of time) to see how "free" he remains.

The second part is standard...to what regulating body will you answer to? Who is going to ensure you are accountable for everything you say you will do?

Who is going to do your taxes? Who is going to do your billing? Who is going to schedule all you IFTs? Who is going to ensure all employment regulations are followed?

None of this will be free and this is just a tad bit of the overhead which you have failed to consider.

You need the community or a large investor to make this happen.

[Richard B the EMT]

First off, this is reminiscent of the string some months ago, from someone who basically wanted to buy a used helicopter, and go into the Medevac business. We all lambasted him on numerous items involved, some just with the helicopter before any medical involvement. However...

1) Inquire of the local and state level Departments of Health as to what needs to be done.

2) See if anyone else in the state does similar work, and contact them to ask what they did, how they did it, what expenses they have, etc.

While I don't believe it will come to fruition, I have been wrong before. Good luck!

[tcripp]

A buddy and I were looking into starting a First Response business for the area we live in. Basically we just want to have a business that responds to emergencies that are either

1. Require additional assistance

2. closer to us than the local fire/ems

and 3. give basic boo boo support

We were curious on how to start this. We will not be transporting patients, so no need for an ambulance. We were thinking more along the lines of POV's instead of ambulances.

Thats pretty much all we want to do. Be the first response to emergencies that fit certain criteria.

We both live in the State of Oregon and have no idea how or where to begin.

Any advice would be helpful!

Thanks!

Wesley

Question for you. Are you proposing being a part of the 911 system so that you are dispatched out as well or are you talking about special events that require first aid support?

In the county in which I work and the two counties bordering where I live, the first thing you need to do is go to the local EMS service and find out if what you propose is even probable. By that I mean, they may have rules in place that will determine if/how one can become a first responder in their service area. Without their support, what you are proposing very well may not have a chance of working.

Toni

Edited June 4, 2011 by tcripp